Abstract

Background: Adolescence represents a significant social and psychological developmental period which can lead to the experimentation with multiple highrisk behaviours. Although associations with problem gambling in youth have been established in the research literature, there is lack of consistency in the results and measures used to assess these constructs while considering the impact of gender and age. The current study examined the relationship between mental health symptoms (anxiety, depression), problem behaviours (aggression, delinquency) and gambling among high-school youth.

Method: Questionnaire responses were collected from 6,818 junior and senior high-school students in a mid-western U.S. community.

Results: Statistical analyses revealed that all mental health symptoms and problem behaviors were related to an increase in gambling frequency and risk for a gambling problem. Of note, both aggressive and delinquent/antisocial problems held the highest risk for gambling problems compared to anxiety and depressive problems. Significant differences were also observed in terms of gender and age.

Conclusion: This study contributes to our understanding of mental health issues and risky behaviors among adolescents.

Keywords

Adolescence; At-risk gambling; Behavioral problems; Mental health

Introduction

Gambling is a prevalent and growing public and mental health concern
amongst adolescents. Recent data suggests that adolescents are
gambling to an increasing extent [1,2], where 36-79% of adolescents
report having gambled over the past year [3-5]. Although adults
tend to gamble more frequently than adolescents, the prevalence of
problem gambling (PG) has been estimated to be two to four times
higher in youth aged 12 to 17, with rates of Problem Gambling (PG)
ranging from 3% to 8% [4,6-8]. Furthermore, an additional 10% to
14% of adolescents who gamble could be considered ‘at risk’ for
PG later in life [9]. With the social acceptance of gambling and
the advent of online forms of gambling, novel and exceedingly
accessible gambling venues have emerged which increase the
potential risk for PG among youth [1,10-13].

On average, age of first gambling experience (for money) has
been reported to be as low as 10 to 12 years of age, which is considerably younger than age of first tobacco, alcohol, or drug
use [6,9]. Further, although adolescents often begin by engaging
in gambling occasionally and for recreational purposes (i.e., social
gambling), they may progress more rapidly than adults from social
gambling to problem or disordered gambling [14,15]. Trends in
gambling behaviors highlight that among youth and adults, the
rate of problem gambling is two times higher amongst males
when compared to females [16,17]. Compared to females, males
report increased risk-taking, begin gambling earlier, commit
more time and money to gambling, wager more frequently, and
experience higher rates of gambling-related problems [9,16].
As disordered gambling may be closely linked to externalizing
behaviors and substance use in males, among females disordered
gambling appears to be more closely associated with symptoms
of depression and avoidance coping styles [18].

Adolescence marks an important period of psychological and
social development which is often accompanied by both positive and negative transitional events. Mental health and behavioral
problems are quite common in adolescents, with high prevalence
rates for depression, anxiety, substance-use and conduct disorder
[19-21]. Of importance, a recent study depicted how internalizing
and externalizing problems can emerge in early childhood and
remain present throughout one’s life [22]. Additionally, youth
often have more responsibility, autonomy and freedom during adolescence, which often leads to increased experimentation
with a variety of high-risk behaviors (including gambling, drinking,
substance use, and unprotected sexual behavior) [4,23]. Finally,
adolescents also tend to manifest high levels of impulsivity and
are generally more vulnerable to social pressure. Combined,
these risk factors increase the likelihood of excessive adolescent
engagement in gambling activities [24].

Gambling during adolescence has been associated with a
wide range of negative psychological, social, and academic
outcomes. For example, rates of anxiety, depression, low selfesteem,
delinquency and substance use have been reported
to be significantly higher in adolescents who gamble [25-29].
Disordered gambling has also been associated with increased
rates of conduct problems, anti-social behaviors, attention deficit/
hyperactivity disorder and internalizing disorders in youth [30-34]. To account for this it has been suggested that gambling could
serve as a maladaptive coping mechanism where adolescents
engage in gambling to dissociate or escape from stressful life
events [10,35]. If these maladaptive coping strategies are not
acknowledged in the early stages of adolescence, continued
gambling behavior could lead to the development of severe
medical or psychiatric problems later in life [33,36-38].

Given the widespread consequences associated with disordered
adolescent gambling, a better understanding of the relationship
between mental health symptoms, problem behaviors and
gambling would support future prevention and intervention
efforts with adolescents. This research sought to identify the
mental health symptoms and problem behaviors associated with
risk for developing a gambling problem and increased gambling
frequency.

Materials and Methods

This study utilized data from the 2016 Alcohol, Drug Addiction
and Mental Health Services (ADAMHS) Board/Wood County
Education Service Center Survey on Alcohol and Other Drug Use
amongst adolescents in junior high and high school in Wood
County, Ohio. Surveys were administered to all public school
students from grades seven to twelve. To ensure informed consent
and anonymity on the survey, each school principal was provided
with a consent form which was given to the parents informing
them of the importance of the survey. Students then completed
the surveys administered by their respective classroom teachers,
were informed that the surveys were completely anonymous,
and were able to withdraw from participation at any time with
no penalty.

Participants

A total of 6,818 adolescents between age 10 and 19 (Mage=14.9 years, SD=1.77) from Wood County Ohio public schools
participated in the study. The sample was evenly distributed by
gender (49% male, n=3, 341) and a large majority of students
identified as Caucasian (79%) (Table 1 for sample demographics).
Wood County, Ohio is located in the American Midwest with an
estimated population of 130,219 of which a majority of residents
identify as white (93%), with 94% of persons over 25 years having
completed their high school education [39].

Demographic characteristics

N

%

Gender

Male

3341

49.0

Female

3224

47.3

Missing

253

3.7

Age

10 - 12

669

9.8

13 - 15

3219

47.2

16 - 19

2675

39.2

Missing

255

3.7

Ethnicity

White

5409

79.3

Black or African American

167

2.4

Latino

276

4.0

Asian

113

1.7

Pacific Islander

16

0.2

Middle Eastern

36

0.5

Native American

34

0.5

Multicultural

205

3.0

Other

114

1.7

Missing

448

6.6

Table 1: Sample demographics.

Of the original 7,136 adolescents who consented and completed
the survey, 318 were excluded prior to conducting the analyses.
Reasons for exclusion included: inconsistent responding (e.g,,
reported using a substance during the past month, but not over
the last year), reported the use of a fake drug, reported using
all drugs at all times in the maximum amount, or reported
participation in all gambling activities on a daily basis.

Measures

Problem behaviors and mental health: Mental health symptoms
and problem behaviors were measured using the Problem
Severity Scale (PSS) from the Ohio Scales for Youth (OSY). The
PSS was developed based on four sources of information: (1)
problem behaviors based on the DSM-IV, (2) common presenting
problems for youth with emotional disturbance, (3) consultations
with childcare service providers, and (4) items from commonly
used instruments assessing psychopathology [40]. Psychometric
studies based on the OSY suggest the PSS is reliable (internal
consistency α =0.93), valid, and sensitive to change [40]. The PSS
consists of 20-items based on common mental health symptoms
(e.g., feeling sad or depressed) and problem behaviors (e.g.,
arguing with others), which are rated on a 6-point Likert scale
ranging from 0 (not at all) to 5 (all of the time). A total score
can by calculated by summing the 20 items, with higher scores
indicating greater levels of overall problem severity.

Bonadio and Tompsett using a confirmatory factor analysis on
the PSS concluded that a four factor model: Aggression, Anxiety,
Depression and Delinquency, were an enhanced representation
of the PSS [41] when compared to the previously hypothesized
two factors model including externalizing and internalizing
symptoms [42]. Each specific factor is associated with a unique
number of items (Aggression=8, Anxiety=3, Depression=6,
Delinquency=3), with higher response scores for each factor
indicating greater problem severity. To better understand the
role of mental health symptoms and problem behaviors in
relationship to gambling related issues, the added score for each
factor score was trichotomized as either low, moderate or high
problem severity.

Participation in gambling: The frequency of gambling
participation on 11 common gambling activities (playing cards,
betting on games of personal skill, betting on sports teams,
lottery tickets, scratch-offs, online poker, mobile device/smart
phone betting, bingo, keno, fantasy sports, and daily fantasy
sports) were assessed. Participants were asked how frequently
they engaged in each activity during the past 12 months on a
5-point Likert scale ranging from 0 (not at all) to 5 (daily).
Frequency of gambling behavior was recoded into a dichotomous
score: frequent gambling (participation more than once a month)
and social/no gambling (participation less than once a month
or not at all). There is ample evidence that increased gambling
frequency has been associated with enhanced risk for a gambling
problem [4,43].

At-risk gambling problems: To measure risk for a gambling
problem, a three-item screen, the NORC DSM-IV Screening for
Gambling Problems-Loss of Control, Lying and Preoccupation
(NODS-CLiP) was administered to assess gambling severity.
This measure was derived from the NODS, a 17-item measure
assessesing gambling severity based on the 10 DSM-IV criteria
for pathological gambling. The NODS-CLiP is a shortened version
of the NODS, including the three most reliable items revealing
PG [44]. The questions in the NODS-CLiP target three crucial
aspects of problem and disordered gambling: preoccupation
with gambling, loss of control while gambling, and lying about
one’s gambling. Each question requires a dichotomous (yes or
no) answer; with an affirmative answer to any of the questions
indicating a high risk for a gambling problem. The NODS-CLiP has
been reported to have excellent sensitivity, capturing 94% of
NODS problem gamblers and has a high specificity level of 0.96 [44].

Results

Chi-square analyses were conducted to better understand the
relationship between mental health symptoms (anxiety and
depression), problem behaviors (aggression and delinquency)
and gambling behaviors (risk for a gambling problem and
frequent gambling) by gender (Table 2). To highlight differences
in the extent of the prior problem behaviors, comparisons were
conducted between those categorized as low problem and high
problem. Table 3 depicts the prevalence and means scores
for aggressive, anxiety, depressive and delinquent/antisocial
problems amongst both males and females.

Overall, 6.7% (n=458) of the sample were at-risk for a gambling
problem, with more males (9.5% of males, n=316), in comparison
to females (3.9% of females, n=126) reporting high scores. In
terms of gambling frequency, 13.1% (n=891) of the sample
could be classified as frequent gamblers (gambling more than
once a month). A higher proportion of males were found to
have gambled frequently (19.2% of males, n=642; 6.6% of
females, n=213). Overall, both males and females with severe
problems on the PSS were significantly more likely to be at-risk
of a gambling problem, χ2 (2, 2779)=51.46, p<0.001 (males); χ2
(2, 2724)=15.38, p<0.001 (females) (Figure 1). This was also the
case for high aggressive problems, χ2 (2, 2839)=49.96, p<0.001
(males); χ2 (2, 2789)=11.66, p =0.003 (females), with 48.4% of
males and 38.9% of females with elevated aggressive problems
being considered at-risk. Further, 32% of males and 47.1% of
females who indicated high anxiety problem were at increased
risk for a gambling problem, χ2 (2, 2891)=40.29, p<0.001 (males);
χ2 (2, 2827)=6.48, p =0.04 (females). Additional analyses revealed
a similar pattern was present for individuals with high depressive
problems, where 38.2% of males and 59% of females with high
depressive problems had increased risk for a gambling problem,
χ2 (2, 2873)=33.0, p<0.001 (males); χ2 (2, 2812)=14.41, p =0.001
(females). Finally, high delinquent/antisocial problems were
also associated with a higher risk of a gambling problem, χ2
(2, 2890)=52.71, p<0.001 (males); χ2 (2, 2837)=11.55, p =0.003
(females), with 22.9% of males and 20.7% of females with high
delinquent/antisocial problems being identified as at-risk for a
gambling problem.

Chi-square analyses revealed that males and females with
high overall problems were significantly more likely to be
frequent gamblers, χ2 (2, 2895)=118.16, p<0.001 (males); χ2 (2,
2832)=56.52, p<0.001 (females) (Figure 1). Moreover, 50.6% of
males and 64.1% of females with high aggressive problems were
frequent gamblers, with males being 3.6 times more likely, χ2 (2,
2956)=132.36, p<0.001, and females being 5 times more likely, χ2
(2, 2899)=85.54, p<0.001, to gamble frequently. Further, males
and females with high anxiety scores were significantly more
likely to gamble frequently, χ2 (2, 3012)=41.0, p<0.001 (males);
χ2 (2, 2937)=35.64, p<0.001 (females), with 27.8% of males and
55.2% of females with high anxiety problems gambling frequently.
Additional analyses revealed that individuals with high depressive
problems were significantly more likely to gamble frequently, χ2
(2, 2993)=44.48, p<0.001 (males); χ2 (2, 2925)=45.77, p<0.001
(females). Within this group, 35.3% of males and 65.2% of
females with high depressive problems gambled frequently.
Finally, males with high delinquent/antisocial problems were 4.7
times more likely, χ2 (2, 2890)=52.71, p<0.001, and females were
5.6 times more likely to be frequent gamblers, χ2 (2, 2837)=11.55,
p =0.003. Specifically, this analysis revealed that 26.6% of males
and 32% of females with high delinquent/antisocial problems
were considered frequent gamblers.

Figure 1: Percentage of males and females with high overall
problem severity on the PSS categorized as having no
risk/risk of problem gambling (PG) and infrequent/
frequent gamblers.

Further chi-square analyses were conducted on the sample based
on the age of the participants (Table 2). Given the significant
relationship between gambling behaviors, mental health
symptoms, behavioral problems and age, it was hypothesized that differences would be similarly found based on age. For the
following analyses, participants were divided into three age
groups; 10-12 years (n=669); 13-15 years (n=3,219); and 16-19
years (n=2,675). Overall, 16-19 year olds were at the highest
risk of a gambling problem (7.5%, n=200), when compared to
10-12 year olds (6.6%, n=44) and 13-15 year olds (6.1%, n=197).
In terms of gambling frequency, a larger proportion of 16-19
year olds gambled more than once a month (14%, n=375), in
comparison to 13-15 year olds (12.9%, n=415) and 10-12 year
olds (9.4%, n=63). The prevalence and mean score of aggressive,
anxiety, depressive and delinquent/antisocial problems amongst
the three age groups are found in (Table 3).

Type of Mental Health

Severity of Mental Health Symptom/Problem Behavior

N

M

SD

Symptom/Problem Behavior

Low

Moderate

High

Overall Problems

Male

39.9% (1159) 28.8% (961) 23.6% (787)

2907

12.08

15.37

Female

25.6% (836) 28.3% (914) 34.2% (1102)

2842

16.62

17.43

10-12 years

35.4% (237) 29.3% (196) 17.6% (118)

551

10.97

14.61

13-15 years

30.9% (995) 29.7% (957) 27.1% (872)

2824

13.82

16.44

16-19 years

28.2% (754) 26.9% (719) 33.7% (902)

2375

15.74

17.05

Aggression Problems

Male

32.5% (1086) 27.7% (924) 28.7% (960)

2970

6.43

7.21

Female

29.3% (944) 30.1% (972) 30.8% (994)

2910

6.84

6.98

10-12 years

35% (234) 29% (194) 21.4% (143)

571

5.53

6.51

13-15 years

31.1% (1002) 28.5% (919) 29.9% (962)

2883

6.72

7.16

16-19 years

29.7% (794) 29.2% (780) 31.9% (852)

2426

6.82

7.17

Anxiety Problems

Male

49.6% (1656) 23.9% (789) 17.2% (576)

3030

1.89

3.15

Female

30.5% (983) 28.3% (913) 32.7% (1055)

2951

3.49

4.16

10-12 years

38.9% (260) 29.7% (199) 18.7% (125)

584

2.20

3.30

13-15 years

40.7% (1310) 27.4% (881) 23.1% (744)

2935

2.57

3.73

16-19 years

40% (1070) 23.6% (630) 28.5% (763)

2463

2.92

3.90

Depressive Problems

Male

50.3% (1679) 17.3% (577) 22.6% (754)

3010

2.98

5.52

Female

32.1% (1036) 20.3% (656) 38.6% (1245)

2937

5.64

7.51

10-12 years

44.7% (299) 21.1% (141) 21.7% (145)

585

3.06

5.62

13-15 years

42.6% (1370) 20.1% (647) 27.9% (897)

2914

4.06

6.64

16-19 years

39.1% (1046) 16.5% (442) 35.9% (960)

2448

4.88

7.00

Delinquent Problems

Male

68.7% (2295) 11.2% (374) 10.8% (362)

3031

0.89

2.33

Female

67.4% (2174) 13.9% (449) 10.6% (341)

2964

0.82

1.97

10-12 years

80.3% (537) 5.8% (39) 2.4% (16)

592

0.29

1.53

13-15 years

74.1% (2384) 9.9% (319) 7.5% (243)

2946

0.62

1.90

16-19 years

57.8% (1545) 17.5% (467) 16.6% (445)

2457

1.27

2.48

Table 3: Descriptive statistics of mental health symptoms and problem behaviors over the last month.

Amongst participants aged 10-12 years, 40.5% of those with
high overall problems on the PSS were at-risk of problem
gambling, χ2 (2, 497)=8.38, p =0.015 and 38.9% were frequent
gamblers, χ2 (2, 551)=17.72, p<00.1 (Figure 2). Moreover, 46.2%
of those with high aggressive problems were at-risk of problem
gambling, χ2 (2, 514)=10.41, p=0.005. Similarly, 51.8% of 10-12
year olds with high aggressive problems were categorized as
being frequent gamblers, χ2 (2, 571)=27.19, p<0.001. Further,
high anxiety problems were not significantly related with being
at-risk for a gambling problem, yet 10-12 year olds with high
anxiety problems were significantly more likely to be frequent
gamblers, χ2 (2, 583)=6.53, p=0.038. Of note, 34.5% of those
with high anxiety problems were considered frequent gamblers.
As for individuals reporting high depressive symptomatology,
44.6% of 10-12 year olds were significantly more likely to gamble
frequently, χ2 (2, 584)=16.09, p<0.001, and 43.6% were at-risk
of a gambling problem, χ2 (2, 529)=7.9, p=0.019. Finally, 10-12
year olds with high delinquent/antisocial problems were not
significantly more likely to be at-risk of a gambling problem,
however, they were 9.2 times more likely to gamble frequently,
χ2 (2, 591)=28.66, p<0.001. Specifically, 12.3% of youth with high
delinquent/antisocial problems were frequent gamblers.

Figure 2: Percentage of males and females with high overall
problem severity on the PSS categorized as having no
risk/risk of problem gambling (PG) and infrequent/
frequent gamblers.

As for high-school students aged 13-15, all mental health symptoms and problem behaviors were significantly associated
with being at-risk for a gambling problem and being identified
as a frequent gambler. High overall problem scores on the PSS
resulted in individuals being significantly more likely to gamble frequently, χ2 (2, 2812)=72.84, p<0.001, and be at-risk for a
gambling problem, χ2 (2, 2683)=13.94, p =0.001 (Figure 2). Of
importance, 49.2% of those with high aggressive problems
were at-risk of a gambling problem, χ2 (2, 2741)=26.88, p<0.001
and 56.4% were categorized as frequent gamblers, χ2 (2,
2871)=117.56, p<0.001. High anxiety and depressive problems
were slightly associated with gambling in this age group, with
individuals reporting high anxiety scores being 1.6 times more
likely to be identified as being at-risk of a gambling problem, χ2
(2, 2784)=6.53, p =0.038, and being a frequent gambler, χ2 (2, 2917)=16.11, p<0.001. Specifically, 33.2% of those with high
anxiety problems were at-risk of a gambling problem and 33.6%
of these were categorized as frequent gamblers. Further, those
youth high reporting depressive symptomatology were 1.6 times
more likely to be at-risk of a gambling problem, χ2 (2, 2763)=7.37,
p =0.025, and were 1.7 times more likely to be frequent gamblers, χ2 (2, 2898)=22.71,
p<0.001. Among 13-15 year olds, 39.7% of those with high
depressive problems were at-risk of a gambling problem and
41.2% were categorized as frequent gamblers. Finally, 18.8%
of participants with high delinquent/antisocial problems were
at-risk of a gambling problem, χ2 (2, 2793)=31.20, p<0.001, and
23% were categorized as frequent gamblers, χ2 (2, 2930)=194.02,
p<0.001.

For adolescents between the ages of 16 and 19, high overall
problem scores on the PSS was associated with being at-risk of
a gambling problem, χ2 (2, 2324)=19.40, p<0.001 and gambling
frequently, χ2 (2, 2365)=26.86, p<0.001 (Figure 2). Results
revealed that 48.5% of those with high aggressive problems
were at-risk of a gambling problem, χ2 (2, 2373)=19.78, p<0.001,
whereas 51.5% of those with high aggressive problems were
categorized as frequent gamblers, χ2 (2, 2413)=51.16, p<0.001.
As for high anxiety and depressive problems, both anxiety, χ2 (2,
2408)=7.89, p =0.019, and depression, χ2 (2, 2393)=7.91, p =0.019,
were significantly related to an increased risk of a gambling
problem. In the current sample, 39.8% of those with high anxiety
problems and 48.5% of those with high depressive problems were
at-risk for a gambling problem. As for gambling frequency, high
anxiety problems, χ2 (2, 2450)=6.27, p =0.04, and high depressive
problems, χ2 (2, 2436)=7.89, p =0.019, only slightly increased the
risk to be categorized as frequent gamblers. Finally, 16-19 year
olds high in delinquent/antisocial problems were 2.4 times more
likely to be at-risk of a gambling problem, χ2 (2, 2400)=28.18,
p<0.001, and 3.7 times more likely to be categorized as frequent
gamblers, χ2 (2, 2443)=100.31, p<0.001. Specifically, 29.4% of
those with high delinquent/antisocial problems were at-risk of
a gambling problem, whereas 36% were categorized as frequent
gamblers.

Discussion

The aim of the study was to identify which types of mental
health symptoms and problem behaviors increase the likelihood
of being at-risk of a gambling problem and associated with
enhanced frequency of gambling, while taking into consideration
gender and age. Results from the study indicate that overall,
aggressive, anxiety; depressive and delinquent/antisocial
symptoms increased the likelihood of males and females
being at-risk of a gambling problem. This was also the case
for gambling frequency. As for individuals aged 13-15 and 16-
19, all mental health problems and problem behaviors were
significantly related to both risks for PG and gambling frequency.
For the 10-12 year olds, high anxiety and delinquency problems
were not significantly related to being at-risk for PG, although
these mental health and behavioral problems were related to
increased frequency of participation in gambling activities. As for depressive and aggressive problems, 10-12 year olds were
significantly more likely to be at-risk for PG or frequent gamblers
when these problems were high in severity.

These findings confirm the association between gambling
behaviors with a range of externalizing and internalizing
symptoms [25,27,28,29,33,38]. The results emphasize the
importance of aggressive and depressive problems in enhancing
the risk for both PG and frequent gambling within both males and
females. Desai, Maciejewski, Pantalon, and Potenza reported that
externalizing and internalizing problems are gender dependent,
with males who gamble expressing more externalizing problems
and females who gamble expressing more symptoms of
depression and avoidance coping [18]. This study confirms these
findings, as aggressive and delinquent problems increased the
likelihood of being at-risk for PG to a larger extent in males when
compared to females. However, delinquent, aggressive, anxiety
and depressive problems increased the likelihood of females
being categorized as frequent gamblers to a larger extent than
in males. To this extent, it may be the case that females with
severe mental health symptoms and problem behaviors are
gambling frequently as an avoidance coping mechanism to help
deal with their difficulties [10], without experiencing significant
preoccupation or loss of control with their gambling behaviors.
Moreover, perhaps females who gamble frequently are gambling
as a maladaptive coping mechanism through which they can
avoid an array of psychological or social problems [4]. As such,
females may more frequently fail to be identified as being at-risk
for PG even though they are gambling often. Furthermore, the
NODS-CLiP may be more sensitive to externalized problems such
as lying and impulsivity. As externalizing symptoms are generally
more prevalent in males [18] this disproportional influence could
help explain why high aggressive and delinquent problems are
more predictive of risk for PG amongst males.

The results for various age groups revealed that severe mental
health symptoms and problem behaviors generally had a higher
likelihood of identifying individuals as frequent gamblers when
compared to identifying them as at-risk for PG. In this sample
of junior-high and high-school students, problem behaviours
and mental health symptoms appeared to increase steadily with
age. As such, increasing age appears to have an influence on the
prevalence of mental health symptoms and problem behaviours,
whether or not gambling is taken into account [19]. In this case,
it is possible that gambling behaviors could exacerbate both
mental health symptoms and problem behaviors during the
earlier stages of adolescence with the hazardous potential of
being maintained over time.

Severe delinquent/antisocial problems within the past month
held the highest risk of identifying participants as being both atrisk
for PG and as frequent gamblers. This result was the case
for both males and females and all age groups analyzed. As
assessed by the PSS, delinquent problems include breaking laws,
skipping school, and lying. This is in congruence with the DSM-IV
categorization of PG which indicates lying about past gambling
as a primary symptom of PG [27,44]. As lying is a core aspect of
both delinquent behaviours and PG, it would be expected that delinquent problem increase risk for PG. Further, this finding
corroborates the study by Räsänen, Lintonen, Tolvanen, and
Konu, who reported that frequent gambling was associated with
higher rates of delinquent behaviors amongst 14-16 year olds
[34]. The impact of age revealed that high delinquent problems
resulted in youth aged 10-12 year olds being 9.2 times more
likely to be frequent gamblers, followed by 13-15 year olds (5.8
times more likely) and 16-19 year olds (3.7 times more likely).
It is possible that younger individuals who gamble illegally are
more prone to a broader range of other rule breaking behaviors
[27,28]. As a result, higher delinquent problems in younger
individuals may be an overall risk factor for problematic gambling
in youth.

High aggressive problems significantly increased the likelihood of
identifying people as being at-risk for PG and frequent gamblers.
Aggressive problems measured through the PSS include arguing
with others, getting into fights, getting angry, and substance
use. Consequently, these results are to be expected as rates
of substance-use and antisocial behaviors are typically higher
in adolescents who gamble [27,32]. Of note, high aggressive
problems revealed females to be 5 times more likely and
males 3.6 times more likely to be frequent gamblers. Since
previous research suggests that both frequent gambling and
high aggressive behaviors are typically more prevalent in males
[9,16,20], it is plausible that females who gamble are doing so
in environments which facilitate and exacerbate aggressive
behaviors as the norm [24]. Considering the prior, it is possible
that females with high aggressive problems may be at a higher
risk of engaging in frequent gambling activities.

Finally younger children, ages 10-12 with high aggressivity
were 6.4 times more likely to gamble frequently and were 3.5
times more likely to be at-risk for PG. These odds ratio were
higher than those for 13-15 year olds (4.3 times; 2.7 times) and
16-19 year olds (2.6 times; 2.3 times), suggesting that severe
aggressive problems are the strongest predictor of risk for PG in
younger adolescents. Perhaps then, younger individuals who are
engaging in impulsive externalizing behaviors such as excessive
anger, fighting and substance-use, are more vulnerable to social
pressure than older adolescents [24]. Further, environments
where adolescents engage in gambling may also predispose
them to other risky behaviours such as substance and alcohol
use [26]. As a result, it may be the combination of impulsivity,
social pressure and environmental influences which drastically
increase the risk of frequent gambling and risk for PG amongst
10-12 year olds, in comparison to older individuals who may be
more resistant to such pressures.

Limitations and Future Directions

Although this study fosters a deeper understanding of the
relationship between mental health symptoms, problem
behaviors and risky gambling behaviors, several noteworthy
limitations must be acknowledged. For one, the use of selfreport
questionnaires to measure mental health symptoms,
problem behaviors and gambling behaviors may have impacted
the acquired prevalence of these constructs as they are sensitive
topics to disclose in spite of the anonymity of the survey.
Additionally, these mental health symptoms and problem
behaviors were measured using a restricted number of items on
a broader problem severity scale. The PSS has been used in the past to assess overall levels of problem severity [40], but not in
regards to the specific areas of aggressivity, anxiety, depressive
and delinquent/antisocial problems. Although these underlying
factors have been validated through confirmatory factor analysis
[41], further psychometric studies are required to confirm these
findings amongst a variety of norm groups and populations.
Second, although the study had a large sample size, the sample
was restricted to junior high school and high school students
in a single geographical area of the United States. Additional
studies may be required to generalize these results to various
populations and cultures. Third, to screen for the risk of PG, a
shortened version of the NODS measure was given due to the
restricted time period allocated to take the survey and available
space within the questionnaire. Although other longer and more
comprehensive assessments of gambling behavior are available,
the NODS-CliP has shown high sensitivity and specificity in prior
research [44].

Conclusion

In conclusion, the current findings support previous research
highlighting the relationship between gambling behaviors and
a variety of mental health symptoms and problem behaviors
in adolescent youth. Of importance, this study describes and
emphasizes the existing differences in gambling behaviors
between males and females and youth of varying ages. High levels
of aggressive, anxiety, depressive and delinquent/antisocial
problems put adolescents at-risk, not only in terms of their
psychological and social wellbeing, but also by increasing their
risk for problematic and disordered gambling behaviors. Given
that gambling has increased in its accessibility and has become
more socially accepted [12,13], enhanced attention must be
drawn to behaviors and symptoms which increase the likelihood
of youth participation in gambling. This study strengthens our
current understanding of these symptoms and as such, can
assist in the development of future intervention programs
targeting problematic gambling behaviours in a holistic manner.
That is, paying attention not only to gambling behaviours, but
the constellation of associated psychological and social sequela
which may vary by gender and age. Future research should aim
to optimize our understanding of problem behaviors and mental
health symptoms resulting in problematic gambling by identifying
variables which moderate this relationship.

Acknowledgments

We would like to thank Loredana Marchica for her insightful
feedback on earlier versions of the manuscript and Yaxi Zhao for
her assistance in data interpretation.

Funding

The authors have no sources of funding to declare.

Competing and Conflicting Interests

The authors have no potential conflicts of interest to declare
with respect to the research, authorship, and/or publication of
this article.

References

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